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09/01/2016 Prior Authorization AETNA BETTER HEALTH OF VIRGINIA Project (VA88) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign and

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01

Obtain a copy of the VA Promacta PA form.

02

Read the instructions carefully before filling out the form.

03

Gather all the necessary information and documents required for the form.

04

Start by entering your personal details such as name, address, contact information, etc.

05

Provide your VA healthcare identification number.

06

Fill out the sections related to your medical condition and the reason for requesting Promacta.

07

Attach any supporting medical documents or prescriptions if required.

08

Review the completed form for accuracy and completeness.

09

Sign and date the form.

10

Submit the filled-out form to the appropriate VA department or representative.

Who needs va promacta pa form?

01

Veterans who require Promacta medication for their medical condition.

02

Individuals who are eligible for VA healthcare benefits.

03

Patients with thrombocytopenia or chronic liver disease who may benefit from Promacta.

04

Veterans who have been prescribed Promacta by their healthcare provider.

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What is va promacta pa form?

Va promacta pa form is a form used to request prior authorization for the medication Promacta.

Who is required to file va promacta pa form?

Patients or healthcare providers who are seeking approval for the medication Promacta are required to file va promacta pa form.

How to fill out va promacta pa form?

Va promacta pa form can be filled out by providing the necessary patient and healthcare provider information, along with details about the medical condition and prescription.

What is the purpose of va promacta pa form?

The purpose of va promacta pa form is to obtain prior authorization for the medication Promacta to ensure proper usage and coverage.

What information must be reported on va promacta pa form?

Va promacta pa form requires information such as patient demographics, healthcare provider details, medical diagnosis, prescription information, and reasons for medication necessity.

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